Sunday, August 31, 2014

When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers.

But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source: taxpayers.

States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed-care plans will give those insurers more money to cover the new expense. Many of those states — such as Florida, Louisiana and Tennessee — did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.

Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.

State Medicaid agencies say they have little choice but to pay the tax for health plans they hire to insure their poorest residents. That's because the tax is part of the health plans' costs of doing business. Federal law requires states to pay the companies adequate rates.

"This situation results in the federal government taxing itself and taxing state governments to fund the higher Medicaid managed care payments required to fund the ACA health insurer fee," said a report by Medicaid Health Plans of America, a trade group.

Meanwhile, many Medicaid managed-care companies have seen their share prices — and profits — soar this year as they gained thousands of new customers through the health law in states that expanded Medicaid. More than half of the 66 million people on Medicaid are enrolled in managed-care plans.

STEEP COSTS FOR STATES

A KHN survey of some large state Medicaid programs found the tax will be costly this year. The estimates are based in part on the number of Medicaid health plan enrollees in each state and how much they are paid in premiums. States split the cost of Medicaid with the federal government, with the federal government paying, on average, about 57%.

• Florida anticipates the tax will cost $100 million, with the state picking up $40 million and the federal government, $60 million.

• Texas estimates the tax at $220 million, with the state paying $90 million and the federal government, $130 million.

• Tennessee anticipates it will owe $160 million, with the state paying $50 million and the federal government, $110 million.

• California budgeted $88 million, with the state paying $40 million and the federal government, $48 million.

• Georgia estimates the tax on its plans at $90 million, with the state paying $29 million and the federal government, $61 million.

• Pennsylvania predicts the tax will cost $139 million, with the state paying $64 million and the federal government, $75 million.

• Louisiana estimates the tax will cost $27 million, with the state paying $10 million and the federal government, $17 million.

Texas is believed to be the only state that has not yet agreed to cover the tax for its health plans, according to state Medicaid and health plan officials. "The premium tax is just another way that the costs of the Affordable Care Act are pushed down to states and families," said Stephanie Goodman, spokeswoman for the Texas Medicaid program.

Medicaid officials in other states complain that paying the tax reduces money they could have spent on covering more services or paying providers.

DIMINISHING RETURNS?

"I do not feel I am getting anything in return for this," said Tennessee Medicaid Director Darin Gordon.

Officials won't know exactly how much states owe until the Internal Revenue Service sends bills to insurers at the end of August and the Medicaid plans submit those to states.

The health insurer tax is estimated to bring in at least $100 billion over the next decade from all insurers, government auditors estimate.

Most non-profit Medicaid health plans are exempt from the tax, which the trade group says gives the non-profits a competitive edge vying for state contracts. "We consider this tax so badly construed that it should be reconsidered because it makes no public policy sense," said Jeff Myers, CEO of Medicaid Health Plans of America.

The trade group, which represents both non-profit and for-profit Medicaid plans, also opposes the tax because it takes money from Medicaid programs that could be used to pay plans to improve care, he said.

The Centers for Medicare & Medicaid Services declined to comment on how states and the federal government are covering part of the tax.

Timothy Jost, a consumer advocate and law professor at Washington & Lee University in Virginia, said the lawmakers intended to cover the costs of the law by including as many groups paying in as possible.

While it may be unusual for the federal government to essentially tax itself, Jost said, the situation is no different from the federal government paying a contractor to provide a service, then having that contractor use some of those dollars to pay state sales tax or federal income tax.

"This tax should not have surprised anyone, and it should have been worked into contract prices," he said.

Paul Van de Water, senior fellow with the left-leaning Center for Budget and Policy Priorities, said neither health plans nor states should be complaining about the taxes because both are benefiting from the law.

"States are benefiting from the Affordable Care Act because with more people getting insured, it is driving down their uncompensated care costs," he said. He noted that is true even in states that did not expand Medicaid under the health law.

"People always like to get a benefit and not have to pay for it," he said. "If we did not have this tax, we would have had to raise the money somewhere else."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation

FERGUSON, Mo. — Down the street from where the body of Michael Brown lay for hours after he was shot three weeks ago, volunteers have appeared beside folding tables under fierce sunshine to sign up new voters. On West Florissant Avenue, the site of sometimes violent nighttime protests for two weeks, voter-registration tents popped up during the day and figures like the Rev. Jesse L. Jackson Sr. lectured about the power of the vote.

In this small city, which is two-thirds African-American but has mostly white elected leaders, only 12 percent of registered voters took part in the last municipal election, and political experts say black turnout was very likely lower. But now, in the wake of the killing of Mr. Brown, an unarmed black 18-year-old, by a white Ferguson police officer, there is a new focus on promoting the power of the vote, an attempt to revive one of the keystones of the civil rights movement.

“A lot of people just didn’t realize that the people who impact their lives every day are directly elected,” said Shiron Hagens, 41, of St. Louis, who is not part of any formal group but has spent several days registering voters in Ferguson with her mother and has pledged to come back here each Saturday. “The prosecutor — he’s elected. People didn’t know that. The City Council — they’re elected. These are the sorts of people who make decisions about hiring police chiefs. People didn’t know.”

N.A.A.C.P. leaders are creating a door-to-door voter registration effort with a jarring reminder as its theme: “Mike Brown Can’t Vote, but I Can.” Senator Claire McCaskill, a Missouri Democrat, is working with others to hold a “candidate school” for people, including young black residents who say they want to serve on a city council or school board but need guidance on what a political campaign requires.

The attempt to galvanize voting comes against a backdrop of intense political struggles over the ballot in the state. In 2000, polls were kept open late in St. Louis because of long lines, and Republicans complained about possible voter fraud — one chapter in what would be a long battle over elections and voting.

Republican lawmakers, who dominate the Missouri legislature, have repeatedly pushed for a measure requiring photo identification for voters at polling places, saying it is needed to combat fraud. Democrats have called those efforts an attempt to discourage minority voters. A 2006 voter ID law was overturned by the State Supreme Court for violating the State Constitution. The latest measure stalled in the State Senate this year.

Local factors in Ferguson complicate matters, too, including a relatively transient population and the timing of municipal elections — held in the spring instead of November, when presidential or congressional elections drive much higher turnout. On the first day of Ms. Hagens’s registration drive, she said, she helped 28 people fill out forms to vote, but five people who approached her to sign up said they were felons and might not be eligible.

Over the last 25 years, the population of Ferguson, now about 21,000, has shifted from nearly three-quarters white to mostly black. Even so, five of the six City Council members are white, as is Mayor James W. Knowles III. Mr. Knowles, who once led the St. Louis Young Republicans, won a second term in April with just 1,314 votes from among the city’s more than 12,000 registered voters. No one ran against him.

Ask people along the streets here why they choose not to vote and they answer, mostly, with shrugs. Voter turnout has been far higher in presidential elections, and some had not even realized there was a mayoral race last spring. “You don’t really see the candidates or even anything about them until a week or two before the election, and even then it’s not much,” said Alyce Herndon, 49, who has voted but, like many here, said she had not had cause to attend Council meetings.

David C. Kimball, a political scientist at the University of Missouri-St. Louis who has studied voting patterns in the county that includes Ferguson, said some other suburbs that became black majority communities earlier than Ferguson, such as nearby Dellwood, have since begun electing black leaders. “There is often a lag time,” he said, noting that Ferguson’s black population was only slightly higher than half the total as recently as 2000.

There are small indications, Mr. Kimball suggested, that black voters in Ferguson had begun to exert at least some political muscle even before Mr. Brown’s death. In a school board election for a district that includes Ferguson residents, three black candidates ran this year, after the removal of a popular black school superintendent. Only one of the three won a seat, but Mr. Kimball said he viewed the campaign as a modest sign of shifting.

Among some Republicans, the mounting political efforts have provoked tension. Told of the voter-registration booth that had appeared near a memorial for Mr. Brown, Matt Wills, the executive director of the state Republican Party, voiced outrage in an interview with Breitbart News. “If that’s not fanning the political flames, I don’t know what is,” Mr. Wills was quoted as saying. “I think it’s not only disgusting but completely inappropriate.”

Other state Republican leaders have distanced themselves from those remarks, and Mr. Wills did not return requests for an interview. “I think he spoke inartfully about one effort,” Ed Martin, chairman of the Missouri Republican Party, said in an interview. “Anything we can do to get more participation is good for all of us.”

Timothy Jones, a Republican who is the speaker of the State House, said any efforts to engage more voters in the political process were a positive development. “If people are lawfully registering people to vote, I have no issue with that at all,” he said.

Democrats, though, said Republican leaders, who control both chambers of the legislature in Jefferson City but not the governor’s office, had a long history of attempting to draw limits on voting that would most affect voting patterns among minorities in St. Louis, Kansas City and places like Ferguson.

“Their record is not about trying to open up the voting process but rather to limit it,” Senator McCaskill said in an interview. She said at another point, “It’s hard for me to believe that they’re sincere since they have blocked every effort for an early-voter law, they’ve put a pretend early-voting bill up where it really doesn’t allow for early voting, they have pushed, all over this country, for voter ID.”

The state has no provision that allows early voting; absentee voting is permitted if a voter provides a specific reason. A petition drive to get anextensive early-voting measure on the ballot this year failed to fulfill a signature requirement, officials said. The legislature approved a separate early-voting measure that will appear on the November ballot, but critics say it is so limited — only six days of early voting and none on weekends — that it amounts to an attempt at putting the issue to rest without giving voters much chance to vote early.

Organizers here speak of sparking a national movement. The leaders say they are undaunted. “This is going to go past Ferguson,” said John Gaskin III, a spokesman for the St. Louis County N.A.A.C.P. and a member of the national board of directors.

“What I’ve told people is I want them to be aware that there’s a Ferguson near you, near every city,” Mr. Gaskin said. “I don’t think people will run out of steam on this one.”

Last weekend, Trayvon Martin’s father urged people to register as he appeared on stage at a peace rally in St. Louis. Over a period of several hours, though, few people came forward to register.

Demarkus Madyun, 26, of St. Louis, said he was already registered but had come to the registration table to update his address.

“If we’re going to try to say that the system has to be corrected for us to receive justice, we have to do everything that we can to be a part of the system,” he said. “Until we have people in office, it will never be better. Not just presidents — mayors, county executives, the governor.”

Without that, he added, “then everything that we’ve done for the last few weeks is for nothing.”

The speech by former US Vice-President Al Gore was apocalyptic. ‘The North Polar ice cap is falling off a cliff,’ he said. ‘It could be completely gone in summer in as little as seven years. Seven years from now.’

Those comments came in 2007 as Mr Gore accepted the Nobel Peace Prize for his campaigning on climate change.

But seven years after his warning, The Mail on Sunday can reveal that, far from vanishing, the Arctic ice cap has expanded for the second year in succession – with a surge, depending on how you measure it, of between 43 and 63 per cent since 2012.

Scroll down for video

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To put it another way, an area the size of Alaska, America’s biggest state, was open water two years ago, but is again now covered by ice.

The most widely used measurements of Arctic ice extent are the daily satellite readings issued by the US National Snow and Ice Data Center, which is co-funded by Nasa. These reveal that – while the long-term trend still shows a decline – last Monday, August 25, the area of the Arctic Ocean with at least 15 per cent ice cover was 5.62 million square kilometres.

This was the highest level recorded on that date since 2006 (see graph, right), and represents an increase of 1.71 million square kilometres over the past two years – an impressive 43 per cent.

Other figures from the Danish Meteorological Institute suggest that the growth has been even more dramatic. Using a different measure, the area with at least 30 per cent ice cover, these reveal a 63 per cent rise – from 2.7 million to 4.4 million square kilometres.

The satellite images published here are taken from a further authoritative source, the University of Illinois’s Cryosphere project.

They show that as well as becoming more extensive, the ice has grown more concentrated, with the purple areas – denoting regions where the ice pack is most dense – increasing markedly.

Crucially, the ice is also thicker, and therefore more resilient to future melting. Professor Andrew Shepherd, of Leeds University, an expert in climate satellite monitoring, said yesterday: ‘It is clear from the measurements we have collected that the Arctic sea ice has experienced a significant recovery in thickness over the past year.

‘It seems that an unusually cool summer in 2013 allowed more ice to survive through to last winter. This means that the Arctic sea ice pack is thicker and stronger than usual, and this should be taken into account when making predictions of its future extent.’

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The speech by former US Vice-President Al Gore (above) was apocalyptic. He said that the North Polar ice cap is falling off a cliff and could be gone in seven years

Yet for years, many have been claiming that the Arctic is in an ‘irrevocable death spiral’, with imminent ice-free summers bound to trigger further disasters. These include gigantic releases of methane into the atmosphere from frozen Arctic deposits, and accelerated global warming caused by the fact that heat from the sun will no longer be reflected back by the ice into space.

Judith Curry, professor of earth and atmospheric sciences at Georgia Institute of Technology in Atlanta, said last night: ‘The Arctic sea ice spiral of death seems to have reversed.’

Those who just a few years ago were warning of ice-free summers by 2014 included US Secretary of State John Kerry, who made the same bogus prediction in 2009, while Mr Gore has repeated it numerous times – notably in a speech to world leaders at the UN climate conference in Copenhagen in 2009, in an effort to persuade them to agree a new emissions treaty.

The ice cap is falling off a cliff. It could be completely gone in summer in as little as 7 years from now

Mr Gore – whose office yesterday failed to respond to a request for comment – insisted then: ‘There is a 75 per cent chance that the entire polar ice cap during some of the summer months could be completely ice-free within five to seven years.’

Misleading as such forecasts are, some people continue to make them. Only last month, while giving evidence to a House of Lords Select Committee inquiry on the Arctic, Cambridge University’s Professor Peter Wadhams claimed that although the Arctic is not ice-free this year, it will be by September 2015.

Asked about this yesterday, he said: ‘I still think that it is very likely that by mid-September 2015, the ice area will be less than one million square kilometres – the official designation of ice-free, implying only a fringe of floes around the coastlines. That is where the trend is taking us.’

For that prediction to come true it would require by far the fastest loss of ice in history. It would also fly in the face of a report last year by the UN Intergovernmental Panel on Climate Change (IPCC), which stated with ‘medium confidence’ that ice levels would ‘likely’ fall below one million square kilometres by 2050.

Politicians such as Al Gore have often insisted that climate science is ‘settled’ and have accused those who question their forecasts of being climate change ‘deniers’.

However, while few scientists doubt that carbon-dioxide emissions cause global warming, and that this has caused Arctic ice to decline, there remains much uncertainty about the speed of melting and how much of it is due to human activity. But outside the scientific community, the more pessimistic views have attracted most attention. For example, Prof Wadhams’s forecasts have been cited widely by newspapers and the BBC. But many reject them.

An area twice the size of Alaska was open water two years ago and is now covered in ice after the arctic ice cap has expanded for the second year in a row

Yesterday Dr Ed Hawkins, who leads an Arctic ice research team at Reading University, said: ‘Peter Wadhams’s views are quite extreme compared to the views of many other climate scientists, and also compared to what the IPCC report says.’

Dr Hawkins warned against reading too much into ice increase over the past two years on the grounds that 2012 was an ‘extreme low’, triggered by freak weather.

‘I’m uncomfortable with the idea of people saying the ice has bounced back,’ he said.

However, Dr Hawkins added that the decline seen in recent years was not caused only by global warming. It was, he said, intensified by ‘natural variability’ – shifts in factors such as the temperature of the oceans. This, he said, has happened before, such as in the 1920s and 1930s, when ‘there was likely some sea ice retreat’.

Dr Hawkins said: ‘There is undoubtedly some natural variability on top of the long-term downwards trend caused by the overall warming. This variability has probably contributed somewhat to the post-2000 steep declining trend, although the human-caused component still dominates.’

Like many scientists, Dr Hawkins said these natural processes may be cyclical. If and when they go into reverse, they will cool, not warm, the Arctic, in which case, he said, ‘a decade with no declining trend’ in ice cover would be ‘entirely plausible’.

Peer-reviewed research suggests that at least until 2005, natural variability was responsible for half the ice decline. But exactly how big its influence is remains an open question – and as both Dr Hawkins and Prof Curry agreed, establishing this is critical to making predictions about the Arctic’s future.

Prof Curry said: ‘I suspect that the portion of the decline in the sea ice attributable to natural variability could be even larger than half.

‘I think the natural variability component of Arctic sea ice extent is in the process of bottoming out, with a reversal to start within the next decade. And when it does, the reversal period could last for several decades.’

This led her to believe that the IPCC forecast, like Al Gore’s, was too pessimistic.

‘Ice-free in 2050 is a possible scenario, but I don’t think it is a likely scenario,’ she concluded.

GOOD NEWS FOR POLAR BEARS...

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The apparent recovery in Arctic ice looks like good news for polar bears.

If there is more ice at the end of the summer, they can hunt seals more easily. Yet even when the ice reached a low point in 2012, there was no scientific evidence that bear numbers were declining, with their estimated total of 20,000 to 25,000 thought to be higher than in the 1970s, when hunting was first banned.

In many Arctic regions, say scientists, they are in robust health and breeding successfully.

Computer model predictions of decline caused by ice melt have also failed to come true. In 2004, researchers claimed Hudson Bay bear numbers would fall from 900 to fewer than 700 by 2011. In fact, they have risen to over 1,000.

However, the main international bear science body, the Polar Bear Specialist Group, admits it has no reliable data from almost half of the Arctic, so cannot say whether numbers are falling or rising.

Scientists have finally solved the mystery of how rocks can move across the flat ground of a dry lake bed in Death Valley, California

Visitors have long been puzzled by the sight of boulder tracks criss-crossing a dusty bowl known as the Racetrack Playa in Death Valley National Park. But two researchers now say the rocks - which can sometimes be heavy and large - are propelled along by thin, clear sheets of ice on breezy, sunny days. They call it "ice shove". "I'm amazed by the irony of it all," paleobiologist James Norris tells the LA Times. "In a place where rainfall averages two inches a year, rocks are being shoved around by mechanisms typically seen in arctic climes."

The findings are based on a lucky accident by James Norris and his cousin Richard Norris - while they were studying the sliding rock phenomenon. They actually witnessed the boulders moving in December when they went to check their time-lapse cameras in the valley. "There was a pop-pop-crackle all over the place in front of us and I said to my cousin, 'This is it'," Richard Norris says in the science journal Nature. They watched some 60 rocks sail slowly by, leaving the well-known snaking trails in the ground. "A baby can get going a lot faster than your average rock," Norris notes. The rocks also don't slide around very often - scientists estimate only a few minutes out of a million - which is why the event has not been noticed before.

Keep these in mind as you contemplate the direction of the American government over the past 50 years and especially since the Obama election.

The Goals of Communism

(as read into the congressional record January 10, 1963, from "The Naked Communist" by Cleon Skousen)

1. U.S. acceptance of coexistence as the only alternative to atomic war.

2. U.S. willingness to capitulate in preference to engaging in atomic war.

3. Develop the illusion that total disarmament of the United States would be a demonstration of moral strength.

4. Permit free trade between all nations regardless of Communist affiliation and regardless of whether or not items could be used for war.

5. Extension of long-term loans to Russia and Soviet satellites.

6. Provide American aid to all nations regardless of Communist domination.

7. Grant recognition of Red China. Admission of Red China to the U.N.

8. Set up East and West Germany as separate states in spite of Khrushchev's promise in 1955 to settle the German question by free elections under supervision of the U.N.

9. Prolong the conferences to ban atomic tests because the United States has agreed to suspend tests as long as negotiations are in progress.

10. Allow all Soviet satellites individual representation in the U.N.

11. Promote the U.N. as the only hope for mankind. If its charter is rewritten, demand that it be set up as a one-world government with its own independent armed forces. (Some Communist leaders believe the world can be taken over as easily by the U.N. as by Moscow. Sometimes these two centers compete with each other as they are now doing in the Congo.)

12. Resist any attempt to outlaw the Communist Party.

13. Do away with all loyalty oaths.

14. Continue giving Russia access to the U.S. Patent Office.

15. Capture one or both of the political parties in the United States.

16. Use technical decisions of the courts to weaken basic American institutions by claiming their activities violate civil rights.

17. Get control of the schools. Use them as transmission belts for socialism and current Communist propaganda. Soften the curriculum. Get control of teachers' associations. Put the party line in textbooks.

18. Gain control of all student newspapers.

19. Use student riots to foment public protests against programs or organizations which are under Communist attack.

20. Infiltrate the press. Get control of book-review assignments, editorial writing, policymaking positions.

21. Gain control of key positions in radio, TV, and motion pictures.

22. Continue discrediting American culture by degrading all forms of artistic expression. An American Communist cell was told to "eliminate all good sculpture from parks and buildings, substitute shapeless, awkward and meaningless forms."

27. Infiltrate the churches and replace revealed religion with "social" religion. Discredit the Bible and emphasize the need for intellectual maturity which does not need a "religious crutch."

28. Eliminate prayer or any phase of religious expression in the schools on the ground that it violates the principle of "separation of church and state."

29. Discredit the American Constitution by calling it inadequate, old-fashioned, out of step with modern needs, a hindrance to cooperation between nations on a worldwide basis.

30. Discredit the American Founding Fathers. Present them as selfish aristocrats who had no concern for the "common man."

31. Belittle all forms of American culture and discourage the teaching of American history on the ground that it was only a minor part of the "big picture." Give more emphasis to Russian history since the Communists took over.

32. Support any socialist movement to give centralized control over any part of the culture--education, social agencies, welfare programs, mental health clinics, etc.

33. Eliminate all laws or procedures which interfere with the operation of the Communist apparatus.

34. Eliminate the House Committee on Un-American Activities.

35. Discredit and eventually dismantle the FBI.

36. Infiltrate and gain control of more unions.

37. Infiltrate and gain control of big business.

38. Transfer some of the powers of arrest from the police to social agencies. Treat all behavioral problems as psychiatric disorders which no one but psychiatrists can understand.

39. Dominate the psychiatric profession and use mental health laws as a means of gaining coercive control over those who oppose Communist goals.

40. Discredit the family as an institution. Encourage promiscuity and easy divorce.

41. Emphasize the need to raise children away from the negative influence of parents. Attribute prejudices, mental blocks and retarding of children to suppressive influence of parents.

42. Create the impression that violence and insurrection are legitimate aspects of the American tradition; that students and special-interest groups should rise up and use united force to solve economic, political or social problems.

43. Overthrow all colonial governments before native populations are ready for self-government.

44. Internationalize the Panama Canal.

45. Repeal the Connally reservation so the United States cannot prevent the World Court from seizing jurisdiction over nations and individuals alike.